NHS waiting lists unlikely to fall in 2023: IFS

By Gabriel Blaazer

One year on from the publication of the NHS elective recovery plan, the IFS has warned that waiting lists are unlikely to fall this year.

New analysis from the Institute for Fiscal Studies (IFS) has found that NHS waiting times targets are unable to be met this year, and that overall waiting lists are likely to flatline in 2023 before finally falling in 2024.

The NHS Elective Recovery Plan was published in February 2022 as the health service began to recover from Covid-19. Its headline ambition was the aim to increase NHS elective activity to 30 per cent above pre-pandemic levels by 2024-25. Also covered in the plan were targets to eliminate waits of more than two years for treatment by July 2022, one-and-a-half-year waits by April 2023, and to reduce waiting times for diagnostic tests, cancer referrals and outpatient appointments.

Although the IFS notes good progress on certain metrics, such as the two-year wait target, the overall elective waiting list grew to 7.2 million incomplete pathways by November 2022. The IFS is now warning that the backlog may not begin to recede until 2024, “due to the lingering effects of Covid-19 and other pressures on the system.”

Although the NHS did treat more patients in November 2022 (1.55 million) than it did in December 2019 (1.48 million) – a result of “steady, if modest, increases in treatment volumes since July” 2022, according to the report – the IFS analysis shows that between January and November 2022, “the NHS treated 6.6 per cent fewer patients from the waiting list” than in the same period in 2019.

To achieve its target of achieving a 30 per cent increase in elective activity by 2024-25, the NHS is seeking to make use of more non-hospital treatment pathways, such as increasing the usage of advice and guidance services. This allows GPs to liaise with consultants before, or instead of, a hospital referral, with the aim of reducing overall referrals to secondary care. These requests have increased from 42,700 in January 2019 to 114,000 in December 2022, a 167 per cent increase.

As such, after accounting for the increase in guidance and advice services, the IFS has calculated that in order to reach its targets by 2024-25, overall elective activity levels will need to increase by 20.9 per cent.

Taking average treatment volumes from September-November 2022 (97 per cent of 2019 levels) as a starting point, the NHS would need to increase treatment volumes by 10.3 per cent annually between now and March 2025. The IFS describe this as “an incredibly high growth rate”, especially considering that between February 2015 and February 2020, treatment volumes grew by an average of 2.9 per cent annually.

Tackling long waits

As set out by the NHS Constitution for England, 92 per cent of patients should wait no longer than 18 weeks from referral to treatment, but NHS figures show that this target was met in just 58 per cent of cases in December 2022, falling from 60.1 per cent the previous month.

The Recovery Plan also included the ambition of eliminating waits of more than two years for NHS treatment by July 2022, something that has largely been achieved, if slightly behind schedule; the number of people waiting for more than two years for treatment fell from 23,300 in February 2022 to 1,400 in November 2022, a 93.9 per cent reduction.

NHS Providers Chief Executive, Sir Julian Hartley, commented: “Trust leaders and their staff have made significant progress in reducing long waits for patients, which is remarkable given the challenging circumstances in which they’re operating. Their success in virtually eliminating two-year waits for elective care and being on track to bring down 18-month waits by April is testament to the hard work of frontline teams.

“Despite progress around two-year waits, however, overall numbers for other target groups have continued to grow. The ambition to eliminate 1.5-2 year waits by April 2023 looks unlikely to be met, with this group growing by 7.4 between January and September 2022 (45,200 to 48,500, respectively.

The total number of people waiting for more than a year to receive treatment also grew during 2022, rising from 300,000 people in February to 410,000 by November. This figure stood at a mere 1,845 in February 2020, and according to the IFS, “illustrates the broader challenge: while waiting lists are continuing to grow overall, it is not mathematically possible for the NHS to reduce the number of people waiting for all time periods. Instead, it can only prioritise reducing some groups, such as those waiting more than two years, while other parts of the waiting list continue to grow.”

Responding to the IFS’ findings, Saffron Cordery, the Deputy Chief Executive of NHS Providers, said: “This has been one of the toughest winters for the NHS, but the hard work of trust leaders and their staff is leading to promising results. Despite demand for urgent and emergency care services remaining very high, ambulance response times have improved considerably.

“However, we’re still not in the clear: waits of 18 months or more have gone up, and trust leaders are deeply concerned that other pressures – including staff shortages and escalating strikes – could not only obstruct future gains but derail ones already made.”

Tim Gardner, Senior Policy Fellow at the Health Foundation, said: “There were 7.2 million people waiting for routine hospital treatment at last count, up from 6 million a year ago. Behind these numbers are patients left in pain, and people enduring unnecessary suffering. The public and government must be under no illusion: there is still a significant mountain to climb before waiting lists are back to a more acceptable level.”

Short-term issues hampering ICS progress, says PAC report

By Gabriel Blaazer

Major new reforms of the NHS will not work until government addresses multiple chronic issues in the service, the Public Accounts Committee (PAC) has said in a report released today.

PAC’s report cites a “decrepit NHS estate, record treatment backlogs [and] workforce and financial issues” as posing risks to the health of the nation, patient safety and the success of integrated care systems (ICSs).

The report has been produced following the Committee’s Introducing Integrated Care Systems inquiry, which was commissioned in 2022. It sought to establish whether ICSs have been set up in a way that will allow them to achieve their objectives of improving population health and healthcare outcomes; tackling inequalities in outcomes, experience, and access to healthcare; enhancing productivity and value for money; and helping the NHS support broader social and economic development.

“While the ambition is right, the tool kit simply isn’t there to deliver on it.”

It states that while ICSs hold the potential to improve population health by joining up services and focusing on preventing the causes of ill-health, the new systems will not be able to achieve their objectives if longstanding challenges facing the NHS and social care remain unresolved. Lead PAC member, Anne Marie Morris MP, said of this tension that “while the ambition [of ICSs] is right, the tool kit simply isn’t there to deliver on it.”

While short-term challenges such as the elective care backlog and A&E waiting times are taking up much of the day-to-day focus of the NHS, PAC’s report argues that ICSs will struggle to progress on their longer-term objectives around population health, reducing health inequalities and preventing avoidable ill-health in the future.

At a national level, it says, “not enough is being done to focus on preventing ill health [and] there do not appear to be effective arrangements for joint working between government departments to tackle the causes of ill-health.” The report also singles out “NHS England’s failure to ensure adequate NHS funded dental care”, as risking an increase in acute dental health problems.

Furthermore, the report expresses concern that “accountability arrangements [for ICSs] appear under-developed [and that] there is a concerning lack of oversight of ICSs.” On concerns over the extent to which ICSs have created an ‘integrated’ system, it states that “it is not clear who will intervene if joint working between the NHS, local government and other partners break down.”

The report does praise the government’s consultative approach during the development of ICSs and attributes the largely positive reception ICSs have received to the fact that different models were trialled before legislation was implemented.

“There is no clear responsibility for ensuring that social care is properly integrated with health care.”

Public Accounts Committee Chair, Dame Meg Hillier MP, said: “Far from improving the health of the nation, staff shortages and the dire condition of the NHS estate pose a constant risk to patient safety. But government seems paralysed, repeatedly rethinking and delaying crucial interventions and instead coming up with plans that do nothing to address the fundamental problems of funding and accountability.

“The ICS reforms have potential but there is no clear responsibility for ensuring that social care is properly integrated with health care or that patients will see the difference on the ground. Changes will not succeed if they are imposed on the NHS in its current state. Government needs to get a grip on the wider, full-blown health and social care crisis it allowed to develop from long before the pandemic.”

Sarah Walter, Director of the ICS Network at the NHS Confederation, commented: “The introduction of ICSs was overwhelmingly supported by the sector. With limited resources and ever-increasing demand for health and care, it makes sense for greater collaboration between the NHS, local government and other partners to improve population health, reduce inequalities, improve efficiency and provide a more joined-up experience for local communities.

“ICSs were never intended as a silver bullet that will solve all the entrenched challenges facing the NHS and social care. Judging their success on this, and after only seven months since entering the statute books, would be unfair as we know these macro issues require additional investment and support at a national level.

The government has two months to respond to the report’s recommendations.

The Public Accounts Committee’s full report can be viewed here.

Research shows patients want more control over how their health data are shared

By Integrated Care Journal

Patients mostly happy to share their data but want to know who and how the information will be used, finds new report from University of Manchester and the Patients Association

Patients support the use of patient data in health research but do not like the idea of companies making money from the use of their health data, finds a new report based on the views of 24 people who took part in two focus groups.

Members of the focus groups were selected to give a diverse representation of age, ethnicity and region.

Forming part of a wider GP Data Trust pilot project, the work by researchers at the Centre for Social Ethics and Policy (CSEP) at the University of Manchester also found high levels of mistrust in organisations, including the NHS, to keep their data secure, record their data accurately, and only use the data for ethical purposes among the patients taking part in the research.

Rachel Power, Chief Executive of the Patients Association, said: “It’s clear that the attempted introduction of schemes to share patients’ health information has damaged patients’ trust in organisations, including the NHS. This is not helpful to anyone, including patients who do understand the value of sharing data for research, healthcare planning and their own well-being.

“CSEP’s research is extremely important, as it suggests a way forward to rebuild trust and, eventually, share healthcare data.”

Sarah Devaney, lead researcher on the project at the University of Manchester, said: “Patients are calling for greater information and transparency about how it is proposed to use their GP data in health research and planning. It’s very important that their views are taken on board in developing health data sharing programmes which give them more control over their data. This can help regain their trust and make them more likely to share their data in vital health research.”

The GP Data Trusts pilot project was prompted by the mass opt-out by patients from health data sharing in response to the announcement of the GP Data for Planning and Research (GPDPR) programme in 2021. The programme has yet to launch. CSEP researchers wanted to understand what had prompted 1 million people to opt-out and what would need to be in place to make people comfortable about sharing their health data.

What the research found

Many participants in the study felt they had not been given enough information about the GPDPR programme. Some participants would have been happy to share their data if they had known more about the programme, but because they had not been given enough information to decide for themselves, they opted out.

Participants were unhappy that NHS Digital, which had launched the programme, had, in their view, simply decided what it would do with their data, rather than asking people to help by sharing their data.

What could be done better

Most participants wanted more information about what their health data would be used for if they shared it and how it would be kept secure. Some wanted to be informed about every use of their data and the benefits achieved.

Participants overwhelmingly wanted more ongoing control over the use of their health data rather than a one-off choice whether or not to share them.

A legal Trust

Holding patient data in a legal Trust was generally supported because participants believed it may help patients to ensure their choices about how their health data are shared, are respected. Participants were keen to see patients involved as Trustees, along with people who had medical knowledge and those who have expertise in the technical aspects of data sharing and security.

Conclusions of the study

Lack of trust in the system was the main reason patients opted out of sharing their GP data in the GPDPR programme. They did not trust that their GP data would be handled securely and only used for purposes they consider ethically acceptable.

The report suggests that to be trusted, any process of data sharing must provide patients with information about who their data is being shared with and why. It must also give patients more opportunity to control the use of their data, for example by being represented as and by Trustees in a legal trust.

Without these features, patients’ concerns over sharing their health data will remain and these could lead to a lack of trust in future health data sharing initiatives.

News, Thought Leadership February 8, 2023

Shared Services in the age of integrated care systems – friend or foe?

By Jordon Beevers

The introduction of integrated care systems (ICSs) gives the NHS a once-in-a-generation opportunity to streamline, standardise and level up care across an area – coordinating services and planning in a way that improves population health and reduces inequalities, writes Jordon Beevers, Director of ICS Solutions, NHS Shared Business Services.

While much has been made of the importance of provider collaboratives and the need to reach beyond the NHS, relatively little attention has been paid to the opportunities presented by back-office integration, with a lack of actionable insight causing some ICSs to put it on the ‘too difficult’ pile.

NHS England 2023/24 Priorities and Operational Planning Guidance stipulates that Integrated Care Boards (ICBs) and providers should work together to:

Develop robust plans that deliver specific efficiency savings and raise productivity consistent with the goals set out in this guidance to increase activity and improve outcomes within allocated resources.
Put in place strong oversight and governance arrangements to drive delivery, supported by clear financial control and monitoring processes.

Plans, it says, should also set out measures to:

Reduce corporate running costs with a focus on consolidation, standardisation and automation to deliver services at scale across ICS footprints.
Reduce procurement and supply chain costs by realising the opportunities for specific products and services.
Improve staff experience and retention.
Use forthcoming digital maturity assessments to measure progress towards the core capabilities set out in What Good Looks Like – the framework that sets out to enable healthcare leaders to digitise, connect and transform services safely – and identify the areas that need to be prioritised in the development of plans.

When it comes to corporate services, however, the problem for the diverse range of organisations coming together to work as one system is in knowing what’s already working well, and what needs improvement.

Using insight diagnostics to provide system-wide data and intelligence can aid decision-making across corporate services

By taking an agnostic and independent view, it’s possible to co-create a holistic, joined-up roadmap for organisations to drive collaboration and best value across ICSs.

Data and benchmarking can help ICSs to transform the back office. Detailed analysis can help identify what’s working well, areas of inconsistency within and across an ICS, where the greatest improvements opportunities lie – and how investments can be best targeted – to support better and more informed decision-making across multiple organisations and identify potential savings.

In this vein, an insight diagnostic exercise we ran with a leading pathfinder ICS highlighted not only the potential for system-wide service improvements, but also significant savings of £7.3 million (26 per cent) on operational expenditure over the next ten years, including cash releasing savings of almost £4 million.

Shared Corporate Services for the digital age – the shared service ecosystem

It is now more than 20 years since the concept of shared services for NHS business support functions came into existence.

Philip Hewitson was acting Chief Executive at Northwick Park & St Marks Hospitals in North London when he was asked to lead the Department of Health’s national programme to develop shared service arrangements for NHS business support functions.

In Hewitson’s view, shared services provide the best of both worlds. They enable the operational and strategic levels of an NHS organisation to concentrate on what they need to without having to worry about managing back-office systems as well.

This frees up NHS Trusts, commissioners – and now ICSs – to concentrate on and develop the job they must do in delivering healthcare, planning, and commissioning health services. There’s less duplication and access to high levels of automation from sophisticated systems that talk to each other. This, in his view, can only improve management and therefore, patient care.

As he puts it, “there’s a whole suite of benefits. Shared services are applicable in so many areas. When skills are so scarce and when money is so tight, why wouldn’t you look to things that already exist?”

John Yarnold, another original proponent of shared services was Finance Director at Plymouth Hospitals NHS Trust when he took up the post of Project Director of the programme.

He points out that to successfully manage the health component of the ICS, the ICB will need transparent financial activity information consolidated at system level, but able to be interrogated at transactional level.

“If I were directing this nationally, I’d make it mandatory for all NHS organisations within an ICS to go with shared corporate services. From a finance and accounting perspective, have one common chart of accounts, one set of common processes, and then introduce enhanced systems to enable consolidation of the accounts at a national or regional level. Then, the ability to extract data from different sources and combine it with financial information. Data that’s available to all partners within an ICS to inform and improve decision-making. That’s what we need.”

Creating a shared services ecosystem of Finance, HR and Procurement services can empower healthcare leaders, giving them control to improve outcomes for their patients, staff and suppliers by reimagining shared corporate services for the digital age.

At NHS Shared Business Services, we’ve crunched the numbers and estimate shared services have the potential to deliver £400 million in operating savings across ICSs, can enable them to realise £726m+ of Procurement savings opportunities and attain 25 per cent in operational savings.

With numbers like these at stake, and ICSs reportedly likely to post a combined deficit of £600 million for the current financial year, we simply cannot afford to let a lack of insight relegate these savings to the ‘too difficult’ pile.

All news

Negotiations at an impasse as further industrial action looms

By Gabriel Blaazer

Almost 9,000 ambulance workers were on strike yesterday (Monday 6th February), with the GMB and Unite also striking across 9 regions in England – the most NHS settings ever affected by a single day of industrial action.

Following Monday’s unprecedented strike action, nurses with the RCN are striking today (7th February), with the Chartered Society of Physiotherapy striking on 9th February and the ambulance union, Unison, striking on 10th February. This means that Wednesday (8th February) will be the only day this week on which no strike action is taking place.

Official figures show that more than 88,000 appointments have been postponed already this winter due to industrial action, yet unions have accused the government of intransigence over the disputes, which centre largely around pay and conditions and a perceived lack of investment in recruitment and retention.

Despite claims that comparatively low pay and high levels of in-work stress are contributing to the difficulty in recruiting and retaining health and care professionals, unions say that the government is in effect refusing to discuss improvements to pay and conditions. There are more than 130,000 vacancies across the NHS in England alone, and a worrying number of health and care professionals plan to leave their jobs in the coming years, citing burnout, anxiety and working in a system that has reached its breaking point.

Further, a recent analysis of official figures has shown that burnout and stress among health staff has led to more NHS staff absence than the Covid-19 pandemic. NHS sickness figures show that more than 15 million working days have been lost since March 2020, more than double were list to Covid infections and self-isolation.

A government spokesperson has claimed that Health Secretary, Steve Barclay, is ready to resume talks with unions, and said that “the Health and Social Care Secretary has held constructive talks with unions on pay and affordability.” This was disputed by the General Secretary of Unite, Sharon Graham, who said that no such discussions were taking place. On the negotiations, she added: “In 30 years of negotiating, I’ve never seen such an abdication of responsibility. Categorically…there have been no conversations on pay whatsoever with Rishi Sunak or Steven Barclay about this dispute in any way, shape, or form.”

Pat Cullen, General Secretary of the RCN, today accused the government of ‘punishing’ nurses for their stance, after Maria Caulfield, (the minister for mental health and women’s health strategy, herself a nurse and RCN member), said that nurses’ pay would be discussed, “but only [for] next year’s deal.” However, all 14 health unions have declined to continue talks on this basis, saying that they would only negotiate a settlement that covers the 2022-23 pay deal.

Hope remains for a breakthrough, however, with the new Chief Executive of NHS Providers, Sir Julian Hartley pointing out that industrial action in Wales and Scotland have been suspended following fresh pay offers.

Saffron Cordery, who until 1st February was interim Chief Executive of NHS Providers, said: “For many trusts, Monday [6 February] will be the toughest challenge they’ve ever had as nurses and ambulance staff strike together for the first time, and in more places than before. Leaders are doing everything they can to prepare by putting plans in place to minimise effects on patients and making sure they can provide high-quality, timely care where possible. But without a resolution, disruption is inevitable.

“We need to do everything we can to ensure industrial action doesn’t become the new normal. The government has the power to end this disruption right now by talking to the unions about working conditions and, crucially, pay for this financial year. Their reluctance to do so is getting in the way of efforts to tackle elective recovery for patients.”

Rachel Harrison, National Secretary of the GMB said: “It’s been almost a month since the Government engaged in any meaningful dialogue – instead, they’ve wasted time attempting to smear ambulance workers. The NHS is crumbling; people are dying and this Government is dithering.”

Empowering young people with digital mental health tools

By Beth Gibbons

Beth Gibbons explains how her team created a digital tool that acts as a single source of truth for the mental health resources available to young people in the area, and how it’s given them more control in their care.

Earlier this year, NHS Gloucestershire’s children and young people’s mental health services launched its digital support finder. On Your Mind Glos aimed to get young people to the right support at the right time and improve their experience of accessing mental health support.

We know that young people can find asking for help with their mental health difficult. We also know that Covid-19 disruption caused waiting lists for mental health support to grow significantly and the barriers to support became difficult. Gloucestershire has a wide range of mental health services for children and young people but following the pandemic, there was a clear need to digitalise access to these services so that people are put in touch with the support they need as quickly and easily as possible.

And so, at the start of 2022, the Trust wanted to explore ways to use digital tools to increase awareness of the range of support available.

One collaborative team

With the support of tech specialists, Made Tech and Mace & Menter, NHS Gloucestershire created a team of designers and technologists along with our NHS staff to research and build this new tool. The work was commissioned rather than built in-house because of the specialist skills and capabilities needed around service design and agile service delivery.

The team worked with clinicians, frontline workers, children, young people and the local community to research user needs. We found that interaction with these specific groups was crucial to help us create a tool that truly worked for those that needed it. Mental health support practitioners, GPs, school nurses and mental health leads in schools were also included in the research to help to understand the specific problems that needed fixing.

These conversations highlighted specific challenges – knowing where and how to access support, the length of waiting times once referred and the lack of support whilst waiting. There were already many services (including outside the NHS) where individuals could get support but it became clear that people simply weren’t aware of them.

The discovery and first version of the tool was completed in 8 weeks. We looked for feedback from our users throughout the whole process, meaning that the final tool truly delivers on the needs of children and young people in Gloucestershire.

A single source for local mental health support information

An online support finder on the dedicated website guides users through a series of questions to understand how they’re feeling and what support they might need. They’re then signposted to the most relevant service for their needs and given useful information about mental health.

The results are available to young people, their parents and carers via the website and SMS. Providing SMS access was an important element of the service as it needed to be accessible and secure for any child or young person to use, regardless of their access to a computer. Just three months after the initial launch, a round of user research revealed that young people like using the service, with more than 2,500 visiting the site to date.

Today, the support finder is an easier solution for young people to understand, find and access over 100 mental health support services while giving them more choice and control of their care. For health practitioners it provides accurate advice and helps them signpost to services.

The Trust is delighted this tool helps children, young people and their families get the right support for them. This means that young people are not being passed around multiple services having to repeat their story. It also means that services are less likely to duplicate triage efforts for the same young person. With the introduction of self-referral young people are empowered to access support earlier, removing potential barriers.

It has since been launched in schools alongside a programme of mental health awareness and has reached around 10,000 young people. While it was developed for young people, it’s expected that professionals, parents and carers will use it too.

A wider impact across the health service

The support finder has been designed with security at its core, making sure user data is protected. The baseline architecture and codebase was developed under open standards principles, making it available to other NHS organisations with similar patient needs to use and adapt for free.

Thorough and rapid discovery, alpha and beta testing phases with one fully collaborative team meant we were able to make the best possible version of this technology. We designed the service based on feedback from users, helping us meet their needs. As a result thousands more young people can now access mental health support quickly.

Beth Gibbons is the Programme Manager for Children’s Mental Health & Maternity at NHS Gloucestershire.

Finding the right support to provide the NHS with the capacity needed

By David Duffy

Dr Jean Challiner, Medical Director for Medinet, outlines how the NHS must harness spare capacity from all corners of the health and care sector to meet this period of unprecedented service demand.

As has been made abundantly clear by the Prime Minister earlier this month, the NHS is suffering from a severe capacity crisis. In addition to emergency departments tackling the toughest winter on record, 7.21 million people are currently on an elective care waiting list and staff shortages are crippling service delivery.

The Prime Minister himself acknowledged that these trends existed prior to Covid-19 but the pandemic has escalated the problem beyond what the NHS is able to tackle without added support. “With so many people waiting longer and longer for elective care, patients’ conditions are worsening and becoming urgent for some,” reflects Dr Jean Challiner, Medical Director for independent healthcare provider, Medinet.

Dr Challiner stresses that for Medinet, who have a two decade history of providing dedicated ‘insourcing’ for NHS trusts to boost capacity, the time patients are spending waiting for treatment is having a drastic impact on their work. “We used to almost exclusively offer capacity in the NHS for low complexity day cases, but now the priorities within the NHS are very different, and there is a growing need for us to address more urgent and more complex cases.”

Medinet holds the country’s largest pool of expert clinicians across 20 different specialties, and supplies teams to provide additional clinical capacity to enable hospitals to meet waiting times targets and then work with them to ensure these are not breached. In the last 12 months, 170,000 patients have been seen and treated by Medinet’s clinical teams.

The fact that Medinet teams work in close conjunction with NHS clinical teams and within existing estates means that they can adapt their service offering to include more complex surgery when needed. This includes cancer surgery and other procedures that fall under the realm of specialised commissioning. Medinet’s large pool of consultants, often made up of part-time NHS doctors or recent retirees, can perform most procedures, although they rarely tackle acute emergency procedures.

Reforming the referral process

Beyond directly boosting capacity with additional staff, Medinet have looked to enhance NHS efficiency and bring down backlog figures by reducing time to referral for patients. With cataract surgery, (accounting for one of the largest elements of the elective waiting list with 600,000 patients waiting for a procedure) patients are now having to wait up to two years to have their cataracts assessed.

“We are seeing some trusts getting twice as many referrals in certain areas as before and you can’t instantly train the necessary staff to meet this demand in the short term,” says Dr Challiner. “Part of our process is to not only bring in additional direct expert capacity where required but also help enhance overall efficiency or perhaps deploy existing resource differently.”

Based on a study conducted with a customer in Scotland, Medinet consultants have recently put forward recommendations to bring down cataract wait times across England, particularly for low risk patients. The study set out to determine the suitability of community cataract referrals for a one-stop cataract surgery service and the target areas for referral refinement. The results of the study showed that waiting time was significantly reduced – an average of 30 weeks for one-stop patients. Approximately one quarter of referrals were considered suitable for the one-stop service and many more may have been suitable if there had been more information in their referrals.

Capitalising on system reform

While Medinet services are still primarily commissioned by individual NHS trusts, the development of integrated care and closer collaboration between individual providers could potentially create opportunities for Medinet to expand its service offering elsewhere. “There is a huge opportunity within ICSs to change the model of harnessing spare capacity and applying [it] to other parts of the system. ICSs must provide the framework for providers to break out of regional, professional and organisational silos and boundaries to alleviate the capacity crisis currently being faced by the NHS.

“As providers evolve their service offerings to meet new challenges, they must be able to highlight where new capacity where is required without fear of reprimand.”

Encouraging active dialogue

Under no illusions, Dr Challiner acknowledges that the Medinet model is not a magic bullet to NHS capacity pressures as there are fundamental obstacles that can restrict impact. “Operating within existing NHS estate allows us to work much closer with NHS teams,” she says, “but we face regular challenges with bed availability, as we cannot conduct day case surgery unless there are beds available for recovery if needed. We also often have difficulty in simply finding the space within a trust for Medinet to operate in work or having a trust staff lead on hand to provide trouble shooting assistance or can locate replacement equipment if required.

“We encourage trusts to highlight new ways in which we can boost capacity. We are seeing an NHS that is working tremendously hard, and we want to help them. Nothing is off bounds for us, to help tackle what is most important, so we need the NHS to talk to us, and engage in discussions to look for possible solutions that are risk assessed and will work.”

Medinet’s position as a capacity booster has placed it in a unique position to reflect on the various challenges that lie within the NHS backlog. Last year, the organisation released its Manifesto for Better, outlining how they plan on supporting hospitals across the country to support commitments to improve access to treatment, empower patient choice, and provide the capacity required in response to the growing backlog of elective services.

Radar Healthcare report ranks UK second on overall healthcare equalities

By Integrated Care Journal

Report from Radar Healthcare shows Canada leading the way on overall healthcare equality, with the UK and other northern European Countries making up the rest of the top six.

A new Healthcare Inequalities Report, released by Radar Healthcare, has ranked 35 of the most developed countries around the world, offering a comprehensive insight into which of these countries offers the best healthcare rights to its citizens through their laws and regulations.

The report places Canada, the UK and Norway in the top three for global healthcare equality, with each generally offering fair and equitable access to healthcare for its citizens.

Radar Healthcare’s report also makes reference to a recent Public Policy Projects report, A Women’s Health Agenda: Redressing the Balance, which produced a series of recommendations aimed at improving the design, delivery and outcomes of women’s healthcare.

While the UK places well overall, the report ranks it number 1 for factors relating specifically to women, with Canada coming in second place.

Below is a snapshot of the report’s findings on maternity and paternity leave.

Maternity and paternity leave

The UK lags behind Denmark and Norway on the ‘paid maternity leave’ metric, offering 39 weeks of paid leave and 13 weeks of unpaid leave, compared with 52 weeks of paid leave in Denmark, while Norway offers 49 weeks of paid leave and 59 weeks of unpaid leave.

The report draws key distinction between paid and unpaid maternity leave; a high number of overall weeks of maternity leave may appear impressive but the degree to which this includes paid leave is highly consequential. For example, Italy offers 4 months of paid maternity leave and 17 weeks of unpaid leave, however, leaving a new mother without a salary for 17 weeks places them in a potentially vulnerable situation, perhaps leaving them more reliant on a partner or family for support.

On paternity leave, the UK scores poorly, scoring offering just 14 days of paid leave to new fathers, while Sweden offers 240 days, the Netherlands 182 days and Denmark 168 days. Germany, meanwhile, has no laws mandating employers to offer new fathers paternity leave, either paid or unpaid.

The lower provision of paid paternity leave is a key metric of gender-based healthcare inequality, since less leave for fathers places more of the burden for childcare on mothers, as well as limiting the valuable bonding time between a newborn and their father.

Further to maternity and paternity leave, the report assesses each country’s standing in regard to the following categories:

The legal age of consent – the age at which a person is considered to be legally competent to consent to sexual acts
Doctor / patient confidentiality ages – the age a resident can speak confidentially to a healthcare professional without parents/guardians being informed
Cervical cancer screening – what age they are recommended for women around the world
Mammogram screening tests – what age they are recommended for women
Flu vaccines – at what age is this offered to elderly residents around the globe
IVF treatment age range – how age impacts the chances of becoming a parent via in-vitro fertilisation in different countries around the world
Cosmetic surgery – at what ages someone can have a cosmetic surgery procedure
Transgender hormone treatment – at what age do healthcare practitioners in different countries allow transgender patients to start hormone treatment
Access to birth control around the world – (age requirements/costs/the countries offering free birth control)
Abortion laws – how they differ across the world

Commenting on the report, Hayley Levene, Head of Marketing at Radar Healthcare, said: “Radar Healthcare partners with organisations such as Public Policy Projects who are learning from experience (both their own and others) to make contributions to the policy debate which address real-world choices on the basis of real-world evidence.

“As a healthcare supplier, Radar Healthcare is passionate about helping to make a difference and delivering improved outcomes. Working with PPP to produce reports such as ‘The Social Care Workforce: averting a crisis’, ‘The Digital Divide: reducing inequalities for better health’ and ‘Integrating Health and Social Care: a national care service’ is vital in helping to drive change and improve some of these health inequalities.

“For example, technology could offer oversight that 80 per cent of patients or healthcare workers themselves are having suicidal thoughts – and this could prompt a process to be followed to tackle it, which will encourage decisions of change.”

To find out more, please visit www.radarhealthcare.com.

First ICS rolls out award-winning healthcare communications app

By Integrated Care Journal

Mid and South Essex Integrated Care System (ICS) has become the first UK care system to make an award-winning communication app available to all its care providers to help tackle health inequalities.

The CardMedic app, designed to improve care for patients who face a communication barrier, is now available to all health and care services in the mid and south Essex area.

The ICS states that more than 35 per cent of people have additional communication needs, which can be due to language, visual or hearing impairment, cognitive impairment, literacy, or other reasons. Communication barriers can contribute to healthcare inequalities, which the newly formed ICS aims to tackle.

“Communication is the first key barrier to health equity and, until you solve that, you can’t move forwards,” said Sarah Haines, Head of Patient Experience and Engagement for Mid and South Essex NHS Foundation Trust.

“Our medical colleagues in the Intensive Care Unit and elsewhere have been excited about using CardMedic, especially the British Sign Language and easy-read options. I’ve been blown away by the potential that CardMedic holds to improve patient experience and safety. It provides people who have struggled to fully participate in their care to be involved in shared decision making with clinicians. Working at ICS level means we can improve communication across multiple settings, enabling more and more people to access the standards of care that they deserve.”

“It helps us to get the simple but important things right.”

Rhona Hayden, a lead out-of-hours nurse at the Trust, and her team, have used the app since May to reduce communication barriers between patients and healthcare professionals, such as language or hearing impairments.

She said: “We have the app downloaded on our tablets and phones and it’s very helpful, especially out-of-hours where we often have to wait for a translator,” she says, explaining that she previously had to rely on picture boards or Google Translate, which are slow and unreliable.

“It helps us to get the simple but important things right, such as not being comfortable in bed,” she adds. “We also use it to make explanations clearer to patients’ families.”

As important stakeholders within the ICS, charity groups have been instrumental in defining how the app can be used to improve patient care. According to Sophie Ede, Chief Executive Officer of Hearing Help Essex, the CardMedic app could be a real “game changer” for improving the accessibility and equity of care across the region.

“One in six of the adult population have hearing loss and acquired hearing loss is most commonly age-related, arriving at a time when people can start to experience many other health conditions” she says.

“All healthcare services have patients with hearing loss, even if the patient themself doesn’t know it,” she explained. “It can be very difficult for people with hearing loss to keep up with what’s being said, especially in an emergency situation.”

Attending A&E can be more challenging for people with hearing loss, as they may not understand what the receptionist, healthcare or allied healthcare professionals are asking. Procedures, such as an emergency c-section, can be even more stressful for people with hearing loss or a language barrier, as they can’t understand what’s being said.

The CardMedic app supports instant translation during consultations and treatment, using a mobile device or tablet. After beginning the roll-out at the Mid and South Essex NHS Foundation Trust hospitals, the ICS will move software deployment into primary care and community-based health settings.

The digital platform hosts a rapidly growing A-Z library of nearly 800 pre-written scripts, replicating conversations between healthcare staff and patients on healthcare topics ranging from obstetrics and maternity to end-of-life care and emergency situations.

The content can be flexed at the point-of-care to different languages, sign language videos, easy read with pictures, or read-aloud. An integrated translation tool supports conversations beyond the content of the scripts.

Dr Sophia Morris, System Clinical Lead for Inequalities, Mid and South Essex Integrated Care System, said, “Being able to ensure all our residents can experience equity of access to healthcare is at the heart of narrowing the gap in health and care inequalities in mid and south Essex. This app will ensure that those who need help communicating and accessing essential services can feel more confident of getting the help and care they need.”

Purple AI: Creating Efficiencies with ‘Intelligent Healthcare’

By Gavin Wheeldon

Manchester-based technology company, Purple, is playing a vital role in the digitalisation of the NHS and wider healthcare system with its innovative ‘Intelligent Healthcare’ solution. Gavin Wheeldon, Chief Executive Officer, discusses the smart technology so desperately needed to create efficiencies.

2022 was undoubtedly another year of weathering the storm, as political instability, the cost-of-living crisis and Russia’s invasion of Ukraine delayed the UK’s post-pandemic recovery.

But for the nation’s NHS and healthcare systems, the storm has been raging for some time, and will continue until drastic action is taken. Spending on healthcare has increased, with core sums expected to reach £176.4 billion for 2023/25 and many are calling for extra funding to be released.

A big injection of cash, however, looks unlikely. Budgets across the UK came under scrutiny as 2022 drew to a close, with tax hikes for all and significant cutbacks due. The government has promised to protect the NHS from such cuts and this is welcome news to many within the healthcare sector, but this alone won’t save it.

The tech making a difference

What the healthcare sector so desperately needs is to free up budget without cutting crucial corners – and at Purple we do just that by using intelligent technology to create significant efficiencies for healthcare institutions.

While it might sound complex, Purple’s smart solutions are actually incredibly simple and deliver ROI and real, meaningful value by increasing day-to-day productivity, reducing loss or misplacement of product, and improving patient experience.

Purple’s new service app, ‘Intelligent Healthcare’, is proudly at the forefront of digital innovations in the healthcare industry. With vital services ranging from real-time location for healthcare employees, digital wayfinding for patients and asset tracking on medicine and products, Intelligent Healthcare provides the most comprehensive, flexible and proven solutions. Our vital tech allows healthcare providers of all sizes to easily adapt their existing tech to meet the growing needs of their patients and speed up processes in the meantime.

Creating efficiencies in healthcare

According to the UK government, increasing employee productivity by just five minutes could save the NHS £280 million a year, yet each nurse spends the equivalent of 40 hours per month searching for equipment. Bridging this gap is our digital wayfinding tech. Combined with the wider Intelligent Healthcare solution, this asset tracking and navigation tool not only allows health experts to monitor and track exact locations of vital equipment, but also provides direct navigation routes to ensure swift and efficient access to these items at all times.

Alleviating unnecessary stress for employees will be crucial for the sector to recruit and retain staff, whilst enabling employees to offer the very best service, achieve job satisfaction and meet rising demands.

A smooth transition for nurses

In September 2022, NHS nurse vacancies reached an all-time high of almost 47,000. In the same breath, NHS agency spend also increased by 20 per cent, according to Nursing Times. With this comes a real influx in temporary (and new) workers flooding into hospitals and healthcare environments. To relieve the mounting pressure on these individuals – and the teams they’re supporting – it’s vital that they have the tools they need to hit the ground running and truly fill the skills gap that is widening every day in the healthcare sector.

A smooth transition is made much easier with Intelligent Healthcare. Hospital buildings and healthcare facilities can, for example, be situated in extremely large buildings which are easy to get lost in – and more recently, emergency facilities have been popping up in new and unfamiliar locations to tackle Covid-19. With the Intelligent Healthcare app, however, healthcare bodies can provide staff and visitors with access to a map of a building and it even allows the user to plot routes to specific locations.

Purple’s LogicFlow alerts also ensure alternative routes are always available in periods of high emergency and it allows immediate and real time communication direct to a users’ phone, for example, ‘if x happens, do y’.

For patients, the technology could save lives. If a monitored patient leaves a specific area – or geozone – an SMS message will be sent to the senior nurse. Six in ten Alzheimer’s and dementia patients tend to wander, and here is just one of many invaluable applications of this technology.

The future of healthcare is digitalisation

Giving the NHS the best possible chance means embracing digital innovation. Taking the small but necessary steps will enable vital transformations and help the NHS overcome the growing number of hurdles.

With a record high of 7.1 million people currently waiting for hospital treatment in the UK, it’s with no doubt that the NHS and wider healthcare systems need end of the line help – and digital transformation is the first step in this journey. Purple are wholly dedicated to making our smart tech solutions work hard for the healthcare sector, to help fill the gaps in the system. If we can go even some of the way in supporting the sector on its road to recovery, we will have been successful.

By making simple changes to improve digital processes, healthcare organisations boost output, increase efficiencies and speed up operations – and completely overhaul the sector in the process.

This article was kindly sponsored by Purple.

To find out more, please visit www.purple.ai/solutions/intelligent-healthcare/